Cost Shift: Medicaid expansion may haunt taxpayers

October 13, 2013

Hundreds of thousands, perhaps millions, of Americans gave up at least temporarily on Obamacare last week, because the government's website didn't work. But here in West Virginia, a related state website was humming right along.

West Virginia is among states that have agreed to expand our Medicaid program under a mandate in the Obamacare law.

To make enrollment more convenient, the state set up a website (www.wvinroads.org). It operated without a glitch last week, allowing nearly 2,000 people to sign up for Medicaid. Another 526 people enrolled at Department of Health and Human Resources offices.

But that success paled in comparison to the state's experience with an "auto-enrollment" program. Earlier this year, 118,000 letters were sent out to people expected to be eligible as new Medicaid enrollees. To sign up, they simply provided some information and mailed the letters back to the DHHR. Nearly 48,000 people have used that process to gain health insurance through Medicaid.

So, at least in comparison to the federal government, West Virginia's DHHR seems to be a model of efficiency.

Now comes the hard part - paying for Medicaid benefits for an estimated 277,000 new enrollees in the Mountain State.

Under Obamacare, the federal government is supposed to cover costs for the new enrollees until 2020, when states are to begin paying 10 percent of the cost. Seven years may sound like a long time, but look at it this way: In all likelihood, the very next governor of West Virginia will have to find a way to pay that 10 percent.

That assumes Congress and the White House do not decide a good way to reduce the federal spending deficit would be to dump more of the burden on states before 2020. Programs meant to aid states in a variety of ways often are first to be cut when federal officials decide to trim spending.

In addition, there's the challenge of paying for the pre-expansion Medicaid program. Finding money for that in Charleston has been exceedingly difficult during the past couple of years.

One reason for that is Washington's decision to increase the percentage of Medicaid costs the state must bear. During fiscal 2010, the federal percentage was slightly above 83 percent. It has been slashed to only about 72 percent.

Clearly, then, the first priority of state officials working with Medicaid needs to be cost containment. Otherwise, West Virginia taxpayers at some point may wish the enrollment process had not operated so smoothly.